Bev Foster • January 9, 2014

Music and Dementia Care: 5 Tips for Caregivers

On January 9, the Room 217 Foundation began a series of free webinars that address issues in music and care. The first webinar addressed Making Meaningful Connections: Music in Dementia Care and was presented by Bev Foster, ED Room 217 Foundation. The following is a part of the webinar. If you would like to register for upcoming webinars, Click Here

Dr. Oliver Sacks, a neurologist and lover of music, is convinced of the music’s unique capacity to connect a person with dementia to their preserved self. He says in his book Musicophilia, “It is the inner life of music which can still make contact with their inner lives, with them; which can awaken the hidden, seemingly extinguished soul; and evoke a wholly personal response of memory, associations, feelings, images, a return of thought and sensibility, an answering identity.” Whether it is because music is used as a trigger, or because it’s a non-verbal means of expression, it has the ability to re-connect neurological pathways that may be intact.

Music can also be used to connect the person living with dementia with their caregivers. In this way, music can improve quality of life, enhance intimacy and communication. What persons living with dementia need and what caregivers seek are activities that give meaning. Music, for most people, is valued. It is my firm belief that we can all use music in care. While there are scopes of practice that have expert training i.e. music therapy, every one of us can learn to integrate music into our regular practice of care. Using the pneumonic SMILE, here are 5 ways you can incorporate music into dementia care:

Sing. You don’t have to be an opera singer or rock star to sing during care procedures. Singing doesn’t mean performing, it means connecting. Think about singing as warm air, vibrations, human contact, PRESENCE. When to sing? During care procedures like bedside transfers, bathing, mealtime, taking medications. You may sing in order to cue these things, to mitigate fear and anxiety. Singing is simple, humming is simple still. It can be done wherever you are. You are focused only on the melody (tune) of music. You can use words or sing the tune only using syllables like LA LA LA. Choose a song that you are familiar with and one that can be used in a number of circumstances in a number of ways. Try LEAN ON ME.

Make musical visits . Musical visits can make good sense, especially for people who enjoy music. A musical visit doesn’t have to be long, 8-10 minutes would be appropriate. Use this format – each time because repetition is good.

Greet – Hello Jenny J (insert person’s name), how are you today? (use the tune Frere Jacques, or make up your own)
Move – depending on condition of person with dementia, take their hand, arm and move it or dance while singing la la la to a more upbeat song i.e. You Are my sunshine
Sing – One Song method – show you that in a moment Choose one song for yourself – it’s your song. You will master it. You will be known for it. Your patients, residents, loved ones, will connect you with that song. When they hear it, they know you’re coming. OR Choose one song for those being cared for. You use it with every patient or resident your care for. It won’t get old because you will change the volume, speed, intensity according to the situation.
OR
Choose one song per task . i.e. bathing – rubber ducky, transfer – humming lean on me, mealtime – I like to eat apples and bananas, bedtime – lullaby, daytime – you are my sunshine
Music-making - with an instrument – I would suggest an egg shaker. It’s small, inexpensive, can go in your pocket, can be easily grasped, it’s sound is gentle gentle and vibrations can be felt Close – same tune and format as Greet
except with something like “It’s time to say good-bye”

Individualize. Evidence suggests that familiar, preferential music is the most therapeutically effective in most situations. A group of nurses began to research the impact of individualized music on their patients. Gerdner and her group researched how personalized music would impact patients. They were interested in how music could modify behaviors. She has developed a guideline for using individualized music. ( Evidence-based guideline. Individualized music for elders with dementia . Gerdner LA, Schoenfelder DP.J Gerontol Nurs. 2010 Jun;36(6):7-15.)

Dan Cohen, a social worker has developed the music and memory project, also known as the ipod project, has developed a protocol for personalized music being delivered through ipods and headphones. Playlists are developed using specific music that is preferential to the person with dementia, specific tunes and specific performers. Often, family members help provide the information for the playlist development. With digital technology so readily available, music can be delivered via an mp3 player or ipod, an ipad. Using headphones make the delivery personal and mobile.

Look for resources. The ipod project has become a popular way of music care delivery to persons with dementia and can be used in home settings and healthcare facilities. Alzheimer Society Toronto has begun an aggressive project hoping that 10,000 ipods will be distributed and used by PWD over the next 3 years. The Room 217 Music Collection can now be delivered in its entirety on ipod shuffle. Meaningful musical activities include sessions with a music therapist, targeting specific outcomes using music. Snoezelen rooms, or sensory stimulation rooms, carts, devices may use music to help persons with dementia reconnect with their surroundings or to reduce anxiety. Singing programs like sing-alongs are becoming more popular but are dependent on people who are confident in music to lead them effectively. A number of LTC residences use videos of entertainers singing familiar music. Some LTC homes have their own singalong programs facilitated live or with recordings. The Alzheimer’s Society in England has an effective program called Singing for the Brain, a weekly gathering of persons with dementia and their caregivers. It is meant to be a safe place for connection around music. Room 217 has 3 videos called Recollections that have been created especially for visual and aural stimulation for persons living with dementia. They are meant to catalyze stories and conversations. Room 217 is developing a series of sing-along episodes on video that will have accompanying activities and training. We are currently in production and hoping to launch Pathways in the fall of 2015.

Evaluate. My favorite educational resource for caregivers looking to integrate music into their regular caregiving routines is a user-friendly book called Connecting through music with people with dementia by music therapist Robin Rio. It is a practical guide for caregivers with helpful tips, checklists and excellent background material. I’ve adapted one of Robin’s checklists, for the E of SMILE. When you are using music in care, you need to access and evaluate its impact. Music may not be for everyone. It might have adverse effects. By evaluating the effects of music on the person with dementia, you will be able to gauge how best to deliver music care for optimal impact. Here are some indicators for you to be aware of:

  • Facial expression
  • Body posture
  • Eye contact
  • Sounds or words
  • Initiation, acceptance, resistance or refusal of physical contact
  • Agitation
  • Reaction to live instruments
  • Reaction to singing
  • Breathing
  • Movement

But He Can’t Hear

By Shelley Neal • May 28, 2026
For most of my practice of coming alongside people in care or at the end of life, my harp has been the extension of me. It has traveled in ICUs, nursing homes, funerals, and celebrations of life. But for George, it couldn’t reach into the depths of his ears or into his soul for soothing, comforting, and connecting. George became profoundly deaf at the end of life. George, in his youth, was a very active and attractive young man with many skills athletically and also musically. Both he and his brother were incredible tenors in their church choirs from youth until their sixties. They sang duets and solos in church and with Gilbert and Sullivan Productions. It was actually there that George met the love of his life, Audrey, and they sang together. In my youth at church, George was often gowned in the choir garb, enjoying the music of the church and those “olde hymns”. Later, George’s father’s work as an assayer took him at the age of 16 to Jamaica, where he fell in love with the folk music of the isle. At home, he loved watching Don Messer’s Jubilee; country music was his soft spot. Often after dinner, he would start the turntable and listen to the crooning of the country and western storytellers. Aging, as they say, is not for the faint of heart. The loss of hearing was a huge adjustment for George, and the loss continued until even the hearing aids no longer worked. I would take Ruby, my little red harp, into the nursing home to play, and he would gently smile in his George way and shake his head that he heard nothing. This is where I became the student during the journey. George would bring out copies of his music, such as old hymns and lyrics of favourite love songs. These copies would be yellowed and delicately thin with age. He would begin to sing in his mellow tenor voice, and the memories flooded back. He shared the copies with fellow residences and staff. He would sing to them all. My job was to listen and take in his rich history of music that journaled the passages of his life. Our favourite haunt in the last nine years was Swiss Chalet, every Sunday evening. Often, our Jamaican staff would come out and sing to George. He really couldn’t catch the words the first couple of times, and then he would lip-read Diane’s words, “Come, Mr. Tally Man, Tally Me Banana,” and everyone at the table and surrounding tables would sing. George would randomly sing songs of the past during these dinners, remembering all the words as well as the moments these songs elicited. Then, the talk and connection went deep. His son, Peter, would take notes about all of these wonderful events of a man who lived a humble life well. Our portal into the life of George often came through old black-and-white photos, old hymn books, even old 78 records. He would smile, close his eyes, relax in his lazy boy, and the vocal music would begin. With the music came the stories of life traveling with his family, the depression, World War 2, meeting Audrey, raising his family, and connection with others through music. Even though he could no longer hear, he remembered and could still give the gift of song to others. The lesson is that music is so much more than sound; it is the connection, the stories, and the memories. We, as music care advocates, need not pass by someone who can’t hear as we may feel not useful, but to think beyond the physical sound into the memories of a song. The use of old pictures and hymn books helped us to enter into the past, as did the conversations cards of Music Care. Our job is one of connection and valuing the humanity of a soul. Music provides rich soil for connection. As our body ages and access to many things diminishes, we must still consider how to adapt our approach of using music to connect, through pictures, conversations, touch, and just being in space together sharing who we are. Shelley Neal is a special education teacher and program coordinator, therapeutic musician, and music care advocate in the Greater Toronto Area. Shelley uses music to deliver curriculum, support movement and language development and communication skills with non-verbal children. Her goal is to come alongside people and use music in whole person care.
A guitar , cowboy hat , cowboy boots and hay are on a wooden table.

When Music Care Becomes Personal (Yet again)

By Shelley Neal • April 2, 2025
I undertook the MUSIC CARE Certification program when I had journeyed through caring for my mother with Alzheimer’s. It was during my training, I learned how music works in terms of timbre, melody and rhythm and beat, music care domains and music care strategies. It helped me to support mom as the disease progressed. I continued to certify through Music Care and then I had the joy of teaching others the level 1 program Fundamentals of Music Care Theory and Context . I have loved coming alongside others in Long Term Care and using music to support giving voice of what is within one’s life, preventing isolation and loneliness, creating community. I enjoyed all it all. Then, I found myself once again in the Emergency Room with Tim, (my family member) as we were helping him home in his palliative journey. My “outside life” took a back seat and my inside hospital life began. Tim’s was failing and he was no longer able to open his mouth and swallow to obtain nutrient’s due to Parkinson’s . We tried various types of foods, textures and flavours, however, opening his mouth and swallowing remained inaccessible. Tim loved Glen Campbell and Rhinestone Cowboy . When he was a young man, he would repeated play this song until the LP was worn through. He was given a new Glen Campbell CD at Christmas and the song was welcomed back into our lives. There I was ,in my new environment on the tenth floor of the hospital, playing Rhinestone Cowboy. Tim sang along. He actually sang along! He moved his mouth, swallowed and sang along. We were able to get pureed food into his body. Later, the disease continued to ravage his body and Rhinestone Cowboy helped us connected with other such as the speech language pathologist, doctors, cleaning staff and nurses. We sang and danced together with the music and Tim smiled. He knew he was part of a community who loved him. As we knew the end was coming, I played music with a simple melody, 60 beats per minute and soft timbre on my harp to support Tim as he fell into sleep. Near the end, I used tonal music in simple phrases to support calmness matching his breath. Tim passed peacefully and gentle. Today, at his funeral our last song “Rhinestone Cowboy”. After hearing the importance of this song, all the people present joined in singing to honour the village of Tim that so lovingly cared for him. Music Care training has become a natural rhythm in my life to use with aging and sick family members, supporting young children’s learning and providing self-care when I was tired after intense caregiving.

Grow

By Shelley Neal • March 8, 2024
I initially trained with MUSIC CARE to work with Seniors in Long Term Care who were experiencing dementia and Alzheimer’s Disease. This is the path I travelled with my mom. My training with Music Care and Room 217 supported capacity building in selecting music that was played on my harp or chosen recorded music. The music centered on the care of the individual and their specific needs. My job was to determine the individual’s specific and select music to address these needs. The music selected helped to build community, support sleep, talk about life experiences, create a background landscape of sound, support connection to decrease isolation and loneliness, as well as coming alongside people dying. My training with Music Care helped me understand how to support people “where they were” physically, emotionally, and spiritually. Through using beat, tempo, melody, and timbre, I could cater the music and desired support required for individuals or small groups. My profession is teaching. I am a special education teacher and use music in my primary teaching as a method for learning, practicing language skills, transmitting information about science studies or math equations, as well as having fun and creating our own songs. My teacher toolkit married exceptionally well with the knowledge and skills provided by the Music Care Certification training. Recently, my work with students has involved individual programming for the medically fragile children and the palliative children. I use music (repeating the chorus several times) to engage and connect with the kiddos. We use music to "talk" about feelings (our communication is through eye gaze, eye blinks, and squeezing hands), and content material. I use music to enjoy our relationship of being together. At times, due to medication for seizures, my little ones can be very sleepy. I increase the tempo, engaging in tapping the beat on her hands and using silly action songs. The giggles and wiggles make it magical. I also use music to tell stories (my students have CVI, cortical vision impairment, so visual perception is difficult). This helps the child to engage in the story arch and adventures. Music is my conduit for reaching out and being with the students. Recently, I had the sacred journey of visiting one of my children in ICU at Sick Kids. I was invited to come to say "goodbye". A dear friend who was an ICU nurse in a different department told me (AKA, insisted) that I bring my harp with me. I wasn't sure if this would be appropriate for the family. However, with the permission of the mom, I bravely packed my harp up and took it to the Unit. It was a beautiful evening of talking with their mom and dad about how special their child was in my life. I played the kiddo's favorite songs and then ended with "The More We Get Together". The little one opened their eyes and stared at me. We hugged, and I left. They passed the next morning. I consider this time to be a sacred gift. Music Care Certification has given me the confidence and toolset to work alongside people and to journey together. It is a time a beautiful, difficult, or sacred time that I have been honoured to participate in.  Thank You

Using Music to Connect with Older Relatives

By Julia Cara • March 29, 2022
This article was written by Julia Cara, and is part of a series provided by upper year Health Sciences students at McMaster University.

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By Bev Foster • January 10, 2022
I will never forget the call that came on that cold, crisp January afternoon twenty years ago. I knew it was imminent. I was expecting it and I thought I was ready. But would I ever be ready to say the final farewell to my father?

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Folk is music of the people, shares news of struggle and home communities

By Deb Bartlett • August 28, 2020
Ask people what folk music is, and you'll get a variety of answers. Is it about the music? The lyrics? The song's history? According to Wikipedia's entry on folk music , it's all of those things: music that's performed by custom over a long period of time; that has no known composers; and that has been transmitted orally. It can describe the traditions of the "uncultured classes" and definitely means it's music of the people. And because it's been shared orally, it is music that has a place, or is indicative of a community. In some circles, because folk music tells stories about events and history, it's known as world music. In a dissertation, Rachel Clare Donaldson simply stated "Folk music is what the people sing."

Secular hymn Hallelujah among world’s most popular and recorded songs

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Not Afraid CD highlights value of relationships at end-of-life journey

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Room 217 ’s music was designed for use in palliative care. The music is produced at 60 beats per minute (resting heart rate) which has several benefits for the person receiving palliative care. It also aids others in the circle of care. This link will take you to a report that discusses the benefits of music in hospice palliative care .

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